Transition to ICD-10-CM Rehabilitation

Transcription

1 Transition to ICD-10-CM Rehabilitation Patricia W. Tulloch RN, BSN, MSN, HCS-D RBC Limited Healthcare & Management Consultants P: E: Integrated OASIS Solutions RBC Limited 2012 Objectives Analyze the ICD-10-CM Chapter 13 categories (M00 -M99) & Chapter 6 categories (G00-G99) Review Chapters 6 & 13 Guidelines Explain ICD-10-CM terminology as it relates to coding diseases of the musculoskeletal & nervous system Identify pathophysiology terms as they relate to coding musculoskeletal and neurological diseases Apply ICD-10-CM to common home health scenarios Integrated OASIS Solutions 2 RBC Limited 2012

2 Housekeeping Information Handout Materials Webcast Participants If you haven t done so already, you can download the handouts and tools in the handout box to the left of your screen. At any time during the presentation you can pause the program. Go to the lower left of the screen and click on the pause button. Please note you may have to scroll down on the page to see the pause button. DVD Participants The main contact should have received the handout materials link in the receipt that was issued upon completion of purchase. If you still need a copy of the handouts, ask your contact or RBC at rbc@netstep.net. your questions to rbc@netstep.net Lastly, for further information about our Education Programs and Products, go to: Integrated OASIS Solutions 3 RBC Limited 2012 Musculoskeletal & Nervous System Primary Focus for Rehab Services 40 million Americans have some form of arthritis Musculoskeletal and Neurologic Diseases are a Primary Focus for Health System Rehabilitation Services Primary Reason for Hospitalization of Medicare Beneficiaries: Falls Home Health is Critical in the Healing Pathway for Neuromuscular Rehabilitation ICD-10-CM codes aligns updated medical terminology & practices with enhanced codes Increased code specificity to track and correlate with quality outcomes & costs Treatment & Best Practice Updates Integrated OASIS Solutions 4 RBC Limited 2012

3 How About Home Care? Rehabilitation Services is the Top Three Reasons for Home Care Services Post Hip Fractures Traumatic; Pathologic Post Joint Replacements Therapy services improves ALL Quality Outcomes Safety Pain Interfering with Activity and/or Movement Healing Status of Surgical Wounds Activities of Daily Living (ADL s & IADL s) Integrated OASIS Solutions 5 RBC Limited 2012 Musculoskeletal System Musculoskeletal System Support Framework Flexible Movement Protects Internal Organs Works with Other Body Systems Homeostasis Heat Generation Structure Muscles, bones, joints Ligaments, tendons, cartilage Supportive Framework Integrated OASIS Solutions 6 RBC Limited 2012

4 Chapter 13: M00-M99 Diseases of the Musculoskeletal System Musculoskeletal System (M00-M99) Diseases & Disorders Intraoperative & postprocedural complications & disorders, NEC (M96) Other diseases of the musculoskeletal system (M99) ICD-10-CM Chapter 13 Guideline Focus Specificity: Site & Laterality Pathologic Fractures Osteoporosis ICD-10-CM Updates terminology to reflect current medical practice Integrated OASIS Solutions 7 RBC Limited 2012 Specific Chapter 13 Blocks M00-M02 Infectious arthropathies M05-M14 Inflammatory polyarthropathies M15-M19 Osteoparthritis M20-M25 Other Joint Disorders M26-M27 Dentofacial Disorders of the Jaw M30-M36 Systemic Connective Tissue Disorders M45-M49 Spondylopathies M60-M63 Disorders of Muscles M65-M67 Other Soft Tissue Disorders M80-M85 Disorders of Bone Density & Structure M86-M90 Other Osteopathies M91-M94 Chondropathies M96 Complications Integrated OASIS Solutions 8 RBC Limited 2012

5 Official Code Guidelines Chapter 13: Diseases of the Musculoskeletal System Site & Laterality Designations Increased Instruction Notes (Code first; Use Additional Code) Enhanced Combination Codes Updated Terminology to Reflect Current Medical Practices Site & Laterality (M00-M99) Multiple sites involved in bone or joint diseases or disorders Code: Multiple Sites If No Multiple Sites code available, then code each different site Bone versus Joint For certain conditions, the bone may be affected at the upper or lower end E.g.: Avascular necrosis of bone (M87); Osteoporosis M 80, M81 Though the portion of the bone may be at the joint, the code designation is the bone, not the joint Integrated OASIS Solutions 9 RBC Limited 2012 More on Code Guidelines Acute Traumatic versus Chronic or Recurrent Musculoskeletal Conditions Bone, joint or muscle conditions that are the result of a healed injury are usually found in Chapter 13 Chronic or recurrent conditions are usually coded from Chapter 13 Current, acute injury should be coded to the appropriate injury code from Chapter 19 Pathologic Fractures 7 th character A is for use as long as the patient is receiving active treatment for the fracture 7 th character D is to be used for encounters after the patient has completed active treatment (subsequent encounters) Integrated OASIS Solutions 10 RBC Limited 2012

6 More on Code Guidelines Osteoporosis Systemic condition; all bones of the musculoskeletal system are effected Site is NOT coded for Osteoporosis M81 Site codes under M80, Osteoporosis currently have a pathologic fracture due to osteoporosis Identifies the site of the fracture, not the site of the osteoporosis Osteoporosis Without a Fracture M81 Code also Hx of pathologic fracture: Z With a fracture M80 Use for any patient with known osteoporosis who suffers a fracture, even if the patient had a minor fall or trauma if that fall or trauma would not usually break a normal, healthy bone. Integrated OASIS Solutions 11 RBC Limited 2012 Compare Code Sets ICD-9-CM Some Combination Codes Assign Additional Codes Traumatic versus Pathologic Fractures ICD-10-CM Expanded Combination Codes with Site & Laterality Expanded Requirements to Assign Additional Codes Expanded Specificity of Type of Fracture 7 th character for encounter & healing status M96 Intraoperative & Postprocedural Complications Integrated OASIS Solutions 12 RBC Limited 2012

7 ICD-10-CM Conventions Ensure Coder Reads Includes notes: Further defines a category Inclusion terms: Some of the conditions included in that code Code first/use additional code notes Code also Two codes may be required but sequencing is dependent upon circumstances See and See Also ICD-10-CM has many more combination codes Specificity; manifestation & complications Integrated OASIS Solutions 13 RBC Limited 2012 Steps to Accurate Coding See Basic Code Rules Identify the main diagnostic term Find the main term in the alphabetical index Read the sub-terms under the main term Follow the cross-reference instructions ALWAYS Verify the code in the Tabular Index Read ALL Instructions * Exclusion notes *NOS (not otherwise specified) * Inclusion notes *NEC (not elsewhere classified) * Code 1st notes *Manifestation notes Integrated OASIS Solutions 14 RBC Limited 2012

8 Code Steps Applied Compression vertebral fracture due to Osteoporosis Step 1 Look up term in Alphabetical Index Osteoporosis (female) (male) M81.0 Osteoporosis with current pathological fracture M80.00 Age related M81.0 With current pathologic fracture M80.00 Fracture Site specific reference codes Vertebra M80.08 Integrated OASIS Solutions 15 RBC Limited 2012 Code Steps Applied Pathologic fracture, vertebrae, due to osteoporosis Step 2 Verify the code in the Tabular index M80.08xD Age-related osteoporosis with current pathological fracture, vertebra(s) x7th character A Initial encounter for fracture D Subsequent encounter for fracture with routine healing G Subsequent encounter for fracture with delayed healing K Subsequent encounter for fracture with nonunion P Subsequent encounter for fracture with malunion S Sequela (late effect) Integrated OASIS Solutions 16 RBC Limited 2012

9 Code Steps Applied Traumatic left hip fracture Step 1 Look up term in Alphabetical Index Fracture, traumatic, hip See fracture, femur, neck Fracture, femur, neck See fracture, femur, upper end, neck Fracture, femur, upper end, neck S Integrated OASIS Solutions 17 RBC Limited 2012 Code Steps Applied Traumatic left hip fracture Step 2 Verify the code in the Tabular index 7th S72.00 Fracture of unspecified part of neck of femur S Fracture of unspecified part of neck of right femur S Fracture of unspecified part of neck of left femur S Fracture of unspecified part of neck of unspecified femur S72.01 Unspecified intracapsular fracture of femur S Unspecified intracapsular fracture of right femur S Unspecified intracapsular fracture of left femur S Unspecified intracapsular fracture of unspecified femur S72.02 Fracture of epiphysis (separation) (upper) of femur Integrated OASIS Solutions 18 RBC Limited 2012

10 7 th Character for Category S72 The appropriate 7 th character is to be added to each code from category S72 A initial encounter for closed fracture B initial encounter for open fracture type 1 or 2 Initial encounter for open fracture NOS C initial encounter for open fracture type IIIA, IIIB, or IIIC D subsequent encounter for closed fracture with routine healing E subsequent encounter for open fracture type 1 or II with routine healing F subsequent encounter for open fracture type IIIA, IIIB, or IIIC G subsequent encounter for closed fracture with delayed healing H subsequent encounter for open fracture type I or II delayed healing Integrated OASIS Solutions 19 RBC Limited th Character for Category S72 The appropriate 7 th character is to be added to each code from category S72 (Cont d) J subsequent encounter for open fracture type IIIA, IIIB, or IIIC K subsequent encounter for closed fracture with nonunion M subsequent encounter for open fracture type I or II with delayed healing N subsequent encounter for open fracture type IIIA, IIIB, or IIIC P subsequent encounter for closed fracture with malunion Q subsequent encounter for open fracture type I or II with malunion R subsequent encounter for open fracture type IIIA, IIIB, or IIIC with malunion S sequela (late effect) Integrated OASIS Solutions 20 RBC Limited 2012

11 Quick Check ICD-10-CM aligns terminology with updated clinical practice. True False ICD-10-CM Code Guidelines instructs coders to code osteoporosis to the specific joint or bone site. True False The use of 7 th characters are optional for a traumatic fracture True False Integrated OASIS Solutions 21 RBC Limited 2012 Arthropathies: M00-M25 M00 Pyogenic arthritis M01 Direct infections of joint in infectious & parasitic diseases classified elsewhere M02 Postinfective & reactive arthropathies M05 Rheumatoid arthritis with rheumatoid factor M08 Juvenile arthritis M10 Gout M12.5 Traumatic arthropathy M15-M19 Osteoarthritis M20-M25 Other joint deformities Integrated OASIS Solutions 22 RBC Limited 2012

12 Osteoarthritis: M15-M19 Group of conditions involving damage to the joint of the body Symptoms Pain; stiffness, swelling Effects large & small joints Rheumatoid arthritis most common Code Selection Type of osteoarthritis Primary, secondary, or traumatic Laterality Treatment Options Integrated OASIS Solutions 23 RBC Limited 2012 More on Osteoarthritis M15 Polyosteoarthritis Includes arthritis of multiple sites M16 Osteoarthritis of hip M16.0 Bilateral primary osteoarthritis of hip M16.1 Unilateral primary osteoarthritis of hip M16.10 Unilateral primary osteoarthritis, unspecified hip M16.11 Unilateral primary osteoarthritis, right hip M16.2 Unilateral primary osteoarthritis of left hip M16.2 Bilateral osteoarthritis resulting from hip dysplasia M17 Osteoarthritis of knee M19 Other and unspecified osteoarthritis Integrated OASIS Solutions 24 RBC Limited 2012

13 One Case Scenario Patient admitted with mild intermittent asthma with an acute exacerbation. Emphysema; CHF; Generalized osteoarthritis. J45.21 Mild intermittent asthma with an acute exacerbation J43.9 Emphysema I50.9 Heart Failure, Unspecified M15.9 Osteoarthritis, generalized Integrated OASIS Solutions 25 RBC Limited 2012 More Code Examples M17.0 Bilateral primary osteoarthritis of knee M17.10 Unilateral primary osteoarthritis, unspecified knee M17.11 Unilateral primary osteoarthritis, right knee M17.12 Unilateral primary osteoarthritis, left knee M17.2 Bilateral post traumatic osteoarthritis of knee M17.30 Unilateral post traumatic osteoarthritis, unspecified knee M17.31 Unilateral post traumatic osteoarthritis, right knee M17.32 Unilateral post traumatic OA, left knee Integrated OASIS Solutions 26 RBC Limited 2012

14 Narrowing of Spine Spinal Stenosis Invertebral foramen Opening between vertebrae Symptoms Pain when walking Difficulty or imbalance when walking Problems controlling urine or bowel movements Problems urinating or having a bowel movement Code Selection Site Manifestations Integrated OASIS Solutions 27 RBC Limited 2012 Some Stenosis Code Examples M48.04 Spinal stenosis thoracic region M48.05 Spinal stenosis thoracolumbar region M99.22 Subluxation stenosis of neural canal of thoracic region M99.32 Osseous stenosis of neural canal of thoracic region M99.42 Connective tissue stenosis of neural canal of thoracic region M99.52 Intervertebral disc stenosis of neural canal of thoracic region Integrated OASIS Solutions 28 RBC Limited 2012

15 More Stenosis Code Examples M48.06 Spinal stenosis lumbar region M48.07 Spinal stenosis lumbosacral region M99.23 Subluxation stenosis of neural canal of lumbar region M99.33 Osseous stenosis of neural canal of lumbar region M99.43 Connective tissue stenosis of neural canal of lumbar region M99.53 Intervertebral disc stenosis of neural canal of lumbar region Integrated OASIS Solutions 29 RBC Limited 2012 One Case Scenario 80 year old female patient admitted with senile osteoporosis. Severe lower back pain. No history of trauma or falls. X-ray revealed spinal stenosis of lumbosacral region. CHF; HTN; Hypothyroidism. M48.07 Spinal stenosis, lumbosacral region M81.0 Age-related osteoporosis without current pathological fracture I50.9 Congestive Heart Failure I10 Essential (primary) HTN I73.9 Insufficiency, vascular, peripheral E03.9 Hypothyroidism (acquired) Integrated OASIS Solutions 30 RBC Limited 2012

16 Bursitis Inflammation of the fluid-filled sac (bursa) of synovial fluid Acute or Chronic Causes Trauma Rheumatoid arthritis Gout Infection Code Selection Type of Bursitis Laterality Integrated OASIS Solutions 31 RBC Limited 2012 Bursitis Code Examples M70.10 Bursitis, unspecified hand M70.11 Bursitis, right hand M70.12 Bursitis, left hand M Other infective bursitis, right hand M Other infective bursitis, left hand M Other infective bursitis, unspecified hand M Rheumatoid bursitis, right hand M Rheumatoid bursitis, left hand M Rheumatoid bursitis, unspecified hand Integrated OASIS Solutions 32 RBC Limited 2012

17 Tendonitis Inflammation of a tendon Causes Connects bone to bone Trauma Overuse Injury Anatomical Code Selection Site Specificity Laterality Integrated OASIS Solutions 33 RBC Limited 2012 Tendonitis Code Examples M76.50 Patellar tendonitis, unspecified knee M76.51 Patellar tendonitis, right knee M76.52 Patellar tendonitis, left knee M76.60 Achilles tendonitis, unspecified M76.61 Achilles tendonitis, right leg M76.62 Achilles tendonitis, left leg M76.70 Peroneal tendonitis, unspecified M76.71 Peroneal tendonitis, right leg M76.72 Peroneal tendonitis, left leg Integrated OASIS Solutions 34 RBC Limited 2012

18 Case Scenario Patient admitted post hospitalization with Type 2 DM. CHF; HTN. Pain right knee due to old tear of the posterior horn of the medial meniscus. Tendonitis of left achilles. Not current surgical candidate. SNV & PT. E11.9 Type 2 Diabetes without complications I50.9 Congestive Heart Failure NOS I10 Essential (Primary) Hypertension M76.62 Achilles tendonitis, left leg M Derangement of posterior horn of medial meniscus due to old tear or injury, right knee Integrated OASIS Solutions 35 RBC Limited 2012 Osteoporosis Thinning of bone tissue and loss of bone density Most common bone disease Symptoms Cause Curvature of spine Hormone changes Code Selection Type of osteoporosis Laterality With or without Fracture (Pathological) Treatment Options Integrated OASIS Solutions 36 RBC Limited 2012

19 Osteoporosis Code Guidelines Review Systemic condition; all bones of the musculoskeletal system are effected Site is NOT coded for Osteoporosis M81 Site codes under M80, Osteoporosis currently have a pathologic fracture due to osteoporosis Identifies the site of the fracture, not the site of the osteoporosis Osteoporosis Without a Fracture M81 Code also Hx of pathologic fracture: Z With a fracture M80 Use for any patient with known osteoporosis who suffers a fracture, even if the patient had a minor fall or trauma if that fall or trauma would not usually break a normal, healthy bone. Integrated OASIS Solutions 37 RBC Limited th Character for Category M80 The appropriate 7 th character is to be added to each code from category M80 A initial encounter for closed fracture D subsequent encounter for closed fracture with routine healing G subsequent encounter for closed fracture with delayed healing K subsequent encounter for fracture with nonunion P subsequent encounter for fracture with malunion S sequela (late effects) Nonunion = Failure to heal normally Malunion= Faulty union of a fractured bone Integrated OASIS Solutions 38 RBC Limited 2012

20 Osteoporosis Code Examples M81.0 Age-related osteoporosis without current pathological fracture Osteoporosis NOS Code also personal history of osteoporosis fracture (Z87.310) M81.6 Localized osteoporosis M81.8 Other osteoporosis without current pathological fracture M80.08x- Age-related osteoporosis with current pathological fracture, vertebrae(s) M Other osteoporosis with current pathological fracture, right hand Integrated OASIS Solutions 39 RBC Limited 2012 Cause Pathological Fractures Weakness of the bone Underlying Etiologies Osteoporosis Neoplasms Infections Cysts Other Bone disorders Code Assignment Site; Laterality; Underlying Condition; Episode of Care (7 th character) Integrated OASIS Solutions 40 RBC Limited 2012

21 7 th Character for Category M84 The appropriate 7 th character is to be added to each code from category M84 A initial encounter for closed fracture D subsequent encounter for closed fracture with routine healing G subsequent encounter for closed fracture with delayed healing K subsequent encounter for fracture with nonunion P subsequent encounter for fracture with malunion S sequela (late effects) Nonunion = Failure to heal normally Malunion= Faulty union of a fractured bone Integrated OASIS Solutions 41 RBC Limited 2012 Code Examples M84.4 Pathologic fracture, NEC M Pathological fracture, right ankle M Pathological fracture, left ankle M Pathological fracture, right foot M84.5 Pathologic fracture in neoplasm disease M Pathological fracture in neoplastic disease, right shoulder M Pathological fracture in neoplastic disease, left shoulder M Pathological fracture in neoplastic disease, unspecified shoulder M84.6 Pathologic fracture in other disease Integrated OASIS Solutions 42 RBC Limited 2012

22 One Case Scenario Patient admitted post hospitalization with a recent diagnosis of thoracic spine bone metastasis from primary breast neoplasm. History of breast cancer 5 years ago. Treatment completed at that time. X-ray confirmed acute fracture of sixth and seventh thoracic vertebrae with evidence of neoplasm lesion. M84.58xD Pathological fracture in neoplastic disease, vertebrae, subsequent encounter, normal healing C79.51 Secondary malignant neoplasm of bone Z85.3 Personal history of malignant neoplasm of the breast Integrated OASIS Solutions 43 RBC Limited 2012 More Case Scenarios Pathological compression fractures of several lumbar vertebrae due to osteoporosis. COPD; HTN. M80.08xD Age-related osteoporosis with current pathological fracture, vertebrae J44.9 COPD I10 Essential (primary) HTN Pathologic fracture, left shoulder due to osteoporosis. Type 2 DM; UTI. M80.812D Other osteoporosis with current path fx; left shoulder E11.9 Type 2 Diabetes mellitus; N39.0 Urinary tract infection Integrated OASIS Solutions 44 RBC Limited 2012

23 Traumatic Fractures Cause Injury (Sports; Vehicles; Other) Code Assignment Anatomic Site Laterality Fracture Type Displaced or nondisplaced Episode of Care (7 th character) Documentation Needs Gustillo Open Fracture Classification System Mechanism of Injury; Soft Tissue Damage Degree of Skeletal Involvement Integrated OASIS Solutions 45 RBC Limited 2012 Code Guidelines Acute Traumatic versus Chronic or Recurrent Musculoskeletal Conditions Bone, joint or muscle conditions that are the result of healed injury are usually found in Chapter 13 Chronic or recurrent conditions are usually coded from Chapter 13 Current, acute injury should be coded to the appropriate injury code from Chapter 19 (S00-S99) Fracture not indicated as open or closed: Code to Closed Fracture not indicated as Displaced or not displaced: Code to Displaced Traumatic Fractures: 7 th Character 7 th character required on all traumatic (acute) fractures Integrated OASIS Solutions 46 RBC Limited 2012

24 Injury & External Cause Extensions Fracture Extensions: 7 th Digit A = Initial encounter for closed fracture B = Initial encounter for open fracture D = Subsequent encounter for fracture with routine healing G = Subsequent encounter for fracture with delayed healing K = Subsequent encounter for fracture with nonunion P = Subsequent encounter for fracture with malunion S = Sequelae Aftercare codes for fractures no longer used Acute fracture with the 7 th character to show subsequent encounter A fracture not indicated as open or closed should be coded to closed S72.009D Fracture, traumatic hip, NOS Integrated OASIS Solutions 47 RBC Limited 2012 Fracture Specificity S72.0 Fracture of head and neck of femur S72.00 Fracture of unspecified part of neck of femur Fracture of hip NOS Fracture of neck of femur NOS S Fracture of unspecified part of neck of right femur S Fracture of unspecified part of neck of left femur S Fracture of unspecified part of neck of unspecified femur Subcapital fracture of femur S Unspecified intracapsular fracture of right femur S Unspecified intracapsular fracture of left femur S Unspecified intracapsular fracture of unspecified femur Transepiphyseal fracture of femur Integrated OASIS Solutions 48 RBC Limited 2012

25 More Fracture Code Examples S42.01 Fracture of sternal end of clavicle S Anterior displaced fracture of sternal end of right clavicle S Anterior displaced fracture of sternal end of left clavicle S42.3 Fracture of shaft of humerous S42.4 Fracture of lower end of humerous S42.9 Fracture of shoulder girdle, part unspecified S42.00x- Fracture of unspecified shoulder girdle, part unspecified S42.91x- Fracture of right shoulder girdle, part unspecified S42.92x- Fracture of left shoulder girdle, part unspecified Integrated OASIS Solutions 49 RBC Limited 2012 One Case Scenario Patient admitted to home health for PT & OT post surgical repair of a commuted fracture of the right intertrochanteric femur. ICD-9-CM ICD-10-CM V57.89 Other rehab procedures S72.141D V54.15 AC for healing traumatic fracture, upper leg Displaced intertrochanteric fx of right femur, subsequent encounter for closed fx with routine healing Integrated OASIS Solutions 50 RBC Limited 2012

26 Another Case Scenario Patient admitted to home health post right hip replacement. SVN for PT/INR & dressing changes. PT for gait training, home safety, muscle strengthening and assistive device. HTN. ICD-9-CM ICD-10-CM V54.81 A/C Joint Replacement Z47.1 A/C joint replacement Abnormal gait Z Right artificial hip joint HTN I10 HTN V58.83 Enctr. Drug monitoring Z51.81 Enctr. therap. drug mn. V58.61 Long term Use of anticoags Z79.01 LT use anticoags V58.31 Dressing Changes Z48.01 Surgical dressing chngs. V43.65 Joint Replaced, Hip Integrated OASIS Solutions 51 RBC Limited 2012 Common Case Scenario Patient admitted post hospitalization for repair of traumatic fracture right hip. Insulin dependent diabetic with neuropathy. HTN; Hyperlipidemia. S72.001D Subsequent encounter for closed fracture with routine healing E11.40 Type 2 Diabetes with neuropathy I10 Essential Hypertension E78.5 Hyperlipidemia Z79.4 Long term current use of insulin Integrated OASIS Solutions 52 RBC Limited 2012

27 Complications: M96 Moved to Procedure Specific Body Systems Chapters Intraoperative & Postprocedural Complications Additional codes to specify nature of complication Example: M Accidental puncture and laceration of a musculoskeletal structure during a musculoskeletal procedure M96.65 Fracture of pelvis following insertion of orthopedic implant, joint prosthesis, or bone plate Integrated OASIS Solutions 53 RBC Limited 2012 Some Complication Codes M96.0 Pseudarthrosis after fusion or arthrodesis M96.1 Postlaminectomy syndrome, NEC M96.2 Postradiation kyphosis M96.3 Postlaminectomy kyphosis M96.4 Postsurgical lordosis M96.5 Postradiation scoliosis M Fracture of humerous following insertion of orthopedic implant, joint prosthesis, or bone plate, right arm M Intraoperative hemorrhage and hematoma of a musculoskeletal structure complicating a musculoskeletal procedure Integrated OASIS Solutions 54 RBC Limited 2012

28 Nervous System Control Center for Entire Body Functions Signals to body Homeostasis Primary Organs Brain Spinal Cord Peripheral Nervous System Code Considerations Laterality Manifestations Integrated OASIS Solutions 55 RBC Limited 2012 Chapter 6: G00-G99 Diseases of the Nervous System & Sense Organs Nervous System (G00-G99) Diseases & Disorders Intraoperative and postprocedural complications and disorders of the nervous system (G97) Other disorders of the nervous system (G99) Eye & Ear Diseases are in two separate Chapters (7 & 8) ICD-10-CM Chapter 6 Guideline Focus Dominance/nondominant side Pain ICD-10-CM Updates terminology to reflect current medical practice Integrated OASIS Solutions 56 RBC Limited 2012

29 Specific Chapter 6 Blocks G00-G09 Inflammatory Diseases G10-G14 Systemic atrophies G20-G26 Extrapyramidal and movement disorders G30-G32 Other degenerative diseases G35-G37 Demyelinating diseases of the CNS G40-G47 Episodic and paroxysmal disorders G50-G59 Nerve, nerve root and plexus disorders G60-G65 Polyneuropathies and other disorders of the peripheral nervous system G80-G83 Cerebral palsy and other paralytic syndromes G89-G99 Other disorders of the nervous system Integrated OASIS Solutions 57 RBC Limited 2012 Official Code Guidelines Chapter 6: Diseases of the Nervous System Site & Laterality Designations Increased Instruction Notes (Code first; Use Additional Code) Enhanced Combination Codes Updated Terminology to Reflect Current Medical Practices Dominant/nondominant Pain Should the affected side be documented, but not specified as dominant or nondominant, and the classification system does not indicate a default, code selection is as follows: For ambidextrous patients, the default should be dominant If the left side is affected, the default is non-dominant If the right side is affected, the default is dominant Acute versus chronic; Pain Management; Other Integrated OASIS Solutions 58 RBC Limited 2012

30 Multiple Sclerosis: G35 Multiple Sclerosis Demyelinating Disease of the Central Nervous System MS G35 Includes: Disseminated multiple sclerosis Generalized multiple sclerosis Multiple sclerosis NOS Multiple sclerosis of brain stem Multiple sclerosis of cord Primary or Secondary Diagnosis List all Pertinent Diagnoses on Plan of Care Resources: National MS Society Integrated OASIS Solutions 59 RBC Limited 2012 Epilepsy: G40 Brain Disorder in which clusters of brain cells send abnormal signals to the body Causes Trauma Congenital Drug induced Other Code Selection Type of Epilepsy Intractable or not intractable With or without status epilepticus Integrated OASIS Solutions 60 RBC Limited 2012

31 Code Guidelines Intractable Considerations Following Terms are considered equivalent to intractable Pharmacoresistant (pharmacologically resistant) Treatment resistant Refractory (medically) and poorly controlled Status Epilepticus (SE) Status epilepticus (SE) is a common, life-threatening neurologic disorder. Essentially an acute, prolonged epileptic crisis Treatment Guidelines Etiology Co-morbidities Integrated OASIS Solutions 61 RBC Limited 2012 ICD-10-CM Epilepsy Examples G40 Epilepsy and recurrent seizures G Localization related (focal)(partial) idiopathic epilepsy and epileptic syndromes with seizures of localized onset, not intractable, with status epilepticus G Localization-related (focal)(partial) idiopathic epilepsy and epileptic syndromes with seizures of localized onset, not intractable, without status epilepticus G Localization-related (focal)(partial) symptomatic epilepsy and epileptic syndromes with simple partial seizures not intractable, with status epilepticus G Localization-related (focal)(partial) symptomatic epilepsy and epileptic syndromes with simple partial seizures not intractable, without status epilepticus Integrated OASIS Solutions 62 RBC Limited 2012

32 CP & Other Paralytic Syndromes Cerebral Palsy Usually appears before the age of 3 Underdeveloped or damaged brain cells impact movement, learning, hearing, sight, and thinking Hemiplegia Complete paralysis of one entire side of body Congenital or acquired Paraplegia Paralysis of lower extremities Acquired or congenital Monoplegia Paralysis of one limb Integrated OASIS Solutions 63 RBC Limited 2012 Code Assignment Requires Documentation Type of paralytic syndrome Laterality Dominant or nondominant side affected, as necessary Code Guidelines Should the affected side be documented, but not specified as dominant or nondominant, and the classification system does not indicate a default, code selection is as follows: For ambidextrous patients, the default should be dominant If the left side is affected, the default is non-dominant If the right side is affected, the default is dominant Check Default Codes by Categories Integrated OASIS Solutions 64 RBC Limited 2012

33 ICD-10-CM Examples G80.0 Spastic quadriplegic cerebral palsy G80.1 Spastic diplegic cerebral palsy G80.2 Spastic hemiplegic cerebral palsy G80.3 Athetoid cerebral palsy G80.4 Ataxic cerebral palsy G81.00 Flaccid hemiplegia affecting unspecified side G81.01 Flaccid hemiplegia affecting the right dominant side G81.02 Flaccid hemiplegia affecting left dominant side G81.03 Flaccid hemiplegia affecting right nondominant side G81.04 Flaccid hemiplegia affecting left nondominant side Integrated OASIS Solutions 65 RBC Limited 2012 More ICD-10-CM Examples G81.90 Hemiplegia, unspecified affecting unspecified site G81.91 Hemiplegia, unspecified affecting right dominant side G81.92 Hemiplegia, unspecified affecting left dominant side G81.93 Hemiplegia, unspecified affecting right nondominant G82.20 Paraplegia, unspecified G82.21 Paraplegia, complete G82.22 Paraplegia, incomplete G82.50 Quadriplegia, unspecified G82.51 Quadriplegia, C1-C4 complete G82.52 Quadriplegia, C1-C4 incomplete G82.53 Quadriplegia, C5-C7 complete G82.54 Quadriplegia, C5-C7 incomplete Integrated OASIS Solutions 66 RBC Limited 2012

34 Case Scenario Patient admitted post hospitalization with acute bronchitis due to streptococcus. Remains on antibiotics for the next 3 days. Patient is a Type 1 diabetic with peripheral vascular disease due to the diabetes. Paraplegic. J20.2 Acute bronchitis due to streptococcus E10.51 Type 1 diabetes with peripheral angiopathy G82.20 Paraplegia, unspecified Integrated OASIS Solutions 67 RBC Limited 2012 More ICD-10-CM Examples G20 Parkinson s Disease Excludes 1 Dementia with Parkinson s (G31.83) G21.0 Malignant neuroleptic syndrome G21.11 Neuroleptic induced parkinsonism G21.19 Other drug induced secondary parkinsonism G24.81 Drug induced subacute dyskinesia G24.82 Drug induced acute dystonia G25.0 Essential tremor G30.0 Alzheimer s disease with early onset G30.1 Alzheimer s disease with late onset G30.8 Other Alzheimer s disease G30.9 Alzheimer s disease, unspecified Integrated OASIS Solutions 68 RBC Limited 2012

35 Another Case Scenario 68 year old MS patient admitted post hospitalization for recurring UTI s secondary to foley catheter. Remains on antibiotics for 5 more days. Suprapubic placed. SNV & Therapy. N39.0 UTI, site not specified Z43.5 Attention to artificial opening: Cystostomy R39.81 Functional urinary incontinence G35 Multiple sclerosis Use additional code for infectious agent, if known Integrated OASIS Solutions 69 RBC Limited 2012 More Case Scenarios Patient admitted PT only for Parkinson s. Therapy to address freezing episodes ; safety; strengthening posterior muscles and gait training Z51.89 Other Physical Therapy G20 Parkinson s Disease Transient cerebral ischemic attack; HTN with Hypertensive Heart Disease; Alzheimer s G45.9 Transient cerebral ischemic attack, unspecified I11.0 Hypertensive Heart Disease with Heart Failure I50.9 Heart Failure, unspecified G30.9 Alzheimer s disease, unspecified Integrated OASIS Solutions 70 RBC Limited 2012

36 Quick Check ICD-10-CM Guidelines direct coders to default to dominant side if the patient s monoplegia is right sided with no other information documented. True False A Z code for aftercare for a fracture is used when there is no surgical intervention post fracture. True False Pathologic fractures are combination codes with the etiology of the fracture, such as osteoporosis. True or False Integrated OASIS Solutions 71 RBC Limited 2012 Complications: M97 Moved to Procedure Specific Body Systems Chapters Intraoperative & Postprocedural Complications Additional codes to specify nature of complication Examples: G97.0 Cerebrospinal fluid leak from spinal puncture G97.2 Intracranial hypotension following ventricular shunting Integrated OASIS Solutions 72 RBC Limited 2012

37 Some Complication Examples G97.1 Other reaction to spinal and lumbar puncture Headache due to lumbar puncture G97.2 Intracranial hypotension following ventricular shunting G97.41 Accidental puncture or laceration of dura during a procedure G97.48 Accidental puncture and laceration of othe nervous system organ or structure during a nervous system procedure G97.51 Postprocedural hemorrhage and hemtoma of a nervous system organ or structure following a nervous system procedure Integrated OASIS Solutions 73 RBC Limited 2012 Consider Coder Challenges Back to Basics Utilize 10 Steps of Code Assignment Use both Alphabetic and Tabular Index Visit: Access searchable database of codes Cannot Rely on Coding Guidance All Previous Guidances Retired with ICD-9-CM Instructions embedded in Tabular Index ICD-10 is the Property of WHO Additional Guidance requires WHO Approval Stay tuned for more information on this process Integrated OASIS Solutions 74 RBC Limited 2012

38 Documentation Needs More Challenges Requires increased specificity in the clinical documentation Specific Documentation Needs Laterality; Severity; Specific Affected site; Clinical Specificity Examples: Age-related osteoporosis with current pathological fracture, left shoulder (M80.012) Chronic gout due to renal impairment (M1a.3) Connective tissue stenosis of neural canal (M99.4) Lung involvement in systemic lupus erythematosus (M32.13) Integrated OASIS Solutions 75 RBC Limited 2012 Agency Risk Areas Lack of access to ICD-10-CM Resources Lack of supporting physician documentation for accurate primary and secondary diagnoses and code assignment Lack of access to precise clinical documentation Lack of substantiating clinician documentation in the OASIS assessment to support the selection and sequencing of primary and secondary diagnoses Not following ICD-10-CM code convention and Code Guidelines Integrated OASIS Solutions 76 RBC Limited 2012

39 Resource Web Sites Centers for Medicare & Medicaid Services ICD-10 Web Site Centers for Disease Control Official ICD-10-CM Code Guidelines AHIMA (American Health Information Management Association) ICD-9-CM Coordination & Maintenance Committee Meetings Board of Medical Specialty Coding Integrated OASIS Solutions 77 RBC Limited 2012 Available Education Programs as Webcasts and DVDs ICD-10-CM Transition - 6 Part Series Available as individual programs. Part 1: Fundamentals, Part 2: Diabetes, Part 3: Cardiovascular, Part 4: Pulmonary, Part 5: Rehabilitation, Part 6: Wounds ACOs: What Impact Do They Have on The Health Care System and Home Care? Infection Control for Home Care and Hospice Question and Answer Session Episodic Payment System (NY) Webcast Series - 2 Part Series Health Care Reform, Palliative Care and Quality of Life Issues - Live Webcast on 7/18/12 (1-2pm EST) 2013 ICD-9-CM Code Updates ICD-9-CM Code Series (Beginner; Intermediate; Advanced) 2013 Home Health PPS Updates FREE Program - Home Health Audit Priorities FREE Program - ICD-10-CM: Coming to Home Health in 2013 For more information on our education programs and products go to: Integrated OASIS Solutions 78 RBC Limited 2012

40 ABOUT RBC LIMITED Our satisfied customers rely on us for our expertise in: PPS and OASIS Training (Integrated OASIS Solutions ); ICD-9-CM Coding; Report Code Scans & Audits; Corporate and Regulatory Compliance; Preparation for Accreditation; Performance Improvement; Clinical Operations; Emergency Disaster Planning; Infection Control; Administration and Organizational Structure; On-site Interim Management; Strategic and Business Continuity Planning; Staff Education and Retreats; Quality Outcome Enhancement; Best Practices and Leadership Development; and HIPAA. RBC Limited Healthcare & Management Consultants Timely, insightful guidance P: E: Integrated OASIS Solutions 79 RBC Limited 2012 This program was brought to you by: Produced by:rbc Management Group Integrated OASIS Solutions 80 RBC Limited 2012